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Question

My 8 year old daughter has developed the habit of picking out her eyelashes and eyebrows. It start just after the start of 2nd grade. We sought the services of a Behavioral Therapist, who decided it was merely a habit (vs. trichotillomania), but who suggested an OT evaluation to rule out sensory issues. Her OT evaluation showed a slight sensory defensiveness, so we completed several months of therapy. This habit ended just after Summer vacation started, and has just started back up a few weeks into 3rd grade. My daughter is a very good student. We have asked her when or why she does the pulling, and she says that she can't remember, that she does it at "different times", etc. She doesn't recognize (or doesn't want to express) what emotions she's experiencing when she picks. In general, she isn't very good at expressing how she feels. How can we help her break this habit?

Answer

Peter Hanfileti, MDReplied:
In my experience, the correlation with school is not a coincidence. It turns out that kids (and all of us) use different "energy settings" in different environments and locations. I would be suspicious that the eyelash and eyebrow pulling is happening in response to external stresses happening while in school which are very likely to be below her level of awareness. I have seen this type of thing in my practice, and there is always more to the story than just the development of a nervous habit.
I would recommend looking at your child from a different perspective, one that includes a more holistic approach and ask the question: "What is there to gain from this hair pulling activity?" One possible answer is the following:
In the Chinese medicine system, the same reservoir of energy required to deal with stresses coming at us from the outside world is the same energy required for such things as: repetitive voluntary movements, keeping muscles relaxed, the inhibition or expression of outward emotions, dealing with frustration and anger, keeping one's thoughts as well as one's surroundings organized, planning for the future, etc.
In this context, I might interpret your child's hair pulling as a way to "prime the pump" in an attempt to mobilize more energy to compensate for the stresses she experiences that are related to school. I'm not talking about grades and homework only. We have to include the peer and teacher relationships, the actual physical environment, previous events that may have happened in school to her or even to other classmates. These all must be included in an evaluation that seeks to elucidate the underlying cause of the symptom or behavior.
You might want to find someone in your local area who is trained to evaluate and treat kids with this type of approach. I have found it to be invaluable with kids I see in my own practice.
Posted On 2010-06-21 15:45:09

Charlotte Cowan, M.D.Replied:
Your concern about your child pulling at her own lashes and hair is well founded, and she is lucky that you care enough to notice and to seek help on her behalf.
Your brief description of your daughter includes some critical details: most notable is that the behavior stopped shortly after the end of the school year and began again when the school started up in the fall. You also note that your daughter has trouble expressing her feelings.
It is my strong sense that your child has some profound feelings associated with school (Performance anxiety? What are her peer relationships like? Is she able to understand and do what is expected of her at school? What do her teachers observe? ) and I would suggest that you take her to a child psychiatrist or therapist for evaluation. A great many children face challenges with which they need support as they grow through the elementary school years. My guess is that the behavioral therapy is missing the boat by not addressing the feelings which underlie and are responsible for her worrisome behaviors.
Again, hats off to you for your attention and willingness to seek help for your daughter! With your support, she will work through whatever is troubling her and be free to enjoy childhood as she should.
Charlotte Cowan, M.D.
Posted On 2009-11-24 06:38:21